APOE and early-onset autosomal dominant Alzheimer disease: These findings are in line with a recent study also using data from the PAC cohort (N = 1819), which reported that higher scores on a composite measure of years education and literacy attenuated the negative effect of APOE-ɛ4 genotype on the rate of decline in episodic memory and a global cognitive score.74 The present results suggest that this reduction in APOE-ɛ4 related cognitive decline among participants with more education may be mediated by reduced atrophy in Alzheimer's disease-vulnerable regions.